AONE GuidinG PriNciPlEs - The Voice of Nursing Leadership

1 aone GuidinG PriNciPlEs For the role of the nurse executive in patient safety Introduction The following toolkit was developed to provide resources must have the competencies necessary to design, to assist nurse leaders and their organizations in coordinate and move forward patient safety PriNciPlEs implementing the aone GuidinG PriNciPlEs for the Role and practices across the domains of governance, of the Nurse Executive in Patient safety . The role of practice/patient care, education and research. This the nurse executive in patient safety is to help lead best can only be accomplished in collaboration with the practices and establish the right culture across multiple interdisciplinary team of health care academia, solution disciplines within the organization. The nurse leader providers, policy makers and the community. Lead Cultural Change Transforming culture change from that of a silent, Increase the amount and quality of feedback to staff hierarchical structure of blame to an open, team-oriented regarding changes made after incidents are reported.

2 Culture will improve patient safety . Human factors Ensure communication about, and understanding of, researcher and author, James Reason (1998) contends organization's critical policies and implications for that a safe culture is an informed culture. An informed failure to comply. culture is one in which those who manage and operate Implement processes that are convenient for broad the system have current knowledge about the human, staff participation. technical, organizational and environmental factors that Engage patients and families by creating a patient determine the safety of a system as a whole.. safety brochure that encourages them to be more Develop a safe culture that assures accountability involved with their care process by speaking up if and respects and values individual contributions and something doesn't seem right or they don't understand perspectives.

3 What is happening. Incorporate safety as a visible design element in the Identify a validated culture of safety survey instrument;. system as a shared Leadership accountability at the monitor progress. most senior level. Provide tools to assist managers and staff with the Provide the knowledge, tools and resources to prepare expectations for improvement. nurses to lead the safety agenda. Report results throughout the organization with the goal Value and promote nurse managers and frontline of transparency. nurses' Leadership in creating the safety culture. Create an audit/monitoring plan; report progress to the Provide patient-centric care by partnering with the board, executive Leadership team and throughout the patient and family to share, understand and align organization. perceptions and reality of the care process. Create an annual patient safety award to recognize outstanding teamwork in making patient care safer.

4 Methods to Lead Cultural Change A safety culture assessment will provide a baseline Recognize and reward reporting of errors and near and raise awareness throughout the organization. misses (just culture response to reporting). The Agency for Healthcare Research and Quality has Increase executive Leadership interactions with staff designed a Survey on Patient safety that will identify on patient safety issues. areas in need of improvement. A copy may be found Enhance workforce knowledge about zero defects. at Enhance skill set in communication of unanticipated outcomes. 1 GuidinG PriNciPlEs Provide Shared Leadership Shared Leadership is when members of a group accept Methods to Provide Shared Leadership responsibility for the work and life of the group. The Integrate patient safety into every activity of the group functions more effectively when there is shared organization.

5 Responsibility, rather than a hierarchical Leadership model. Shared governance is the system that facilitates Pay strict attention to detail. shared Leadership . It creates a forum for collective Keep the patient as the focus. wisdom by creating standards of practice, measuring the Develop systems and processes that recognize the effectiveness of the decision and fostering an environment variations that exist and the potential for error. that empowers the group to continually improve its Surround yourself with like-minded professionals to processes and practice. move the cause forward. Move from hierarchical Leadership models to one of Create a design/model that fits your organization and shared interdependence. one that embeds integrity and sustainability. Understand best practices and research tools used to Leverage the Voice of the bedside nurse and continue create shared governance models.

6 To enhance competencies. Define the role of the nurse at the Leadership table for Provide acknowledgement that each member of the patient safety . shared Leadership team may have their own mix of Gain the perspective of other senior leaders, such as the needs and wants, these needs and wants are essential CFO and CEO, to effectively communicate a business case to groups' healthy functioning. They provide some of for safety initiatives. Integrate the business requirements of the motivation, energy and glue for group life. the organization with patient safety requirements. Actively participate in pay-for-performance initiatives to create a bridge between financial/business organizational issues and patient safety . Build External Partnerships External partnerships are essential for driving patient Methods to Build External Partnerships safety agendas.

7 The nurse executives and the external Improve external partnerships by defining the current partners stand to gain great benefits through collaboration. relationship and identifying the gaps. The collaboration involves the nurse leaders learning the latest best practices around managing people, developing Set goals/objectives for each type of relationship processes and implementing solutions from various organi- (Figure 1). Keep in mind that each relationship will add zations; and the partnering organizations develop a greater unique value to your knowledge portfolio. appreciation and understanding of the problems a nurse Map out what information you would like to gain from executive is trying to overcome to improve patient safety . each relationship. This helps ensure your time is spent Drive the patient safety agenda through collaboration wisely and your relationship portfolio is well diversified.

8 And partnerships. Use the set objectives to enable you to better Reach out to academia, technology solution providers, communities, policy makers, regulatory agencies, state understand how to use the information gained, leverage and federal agencies and professional organizations to any synergies between the groups and determine if advocate for Nursing and patient safety . there are any additional types of relationships that you Proactively develop partnerships with academic would like to form. institutions to drive effective curriculums that reflect Once your goals/objectives are set, select an working realities and include PriNciPlEs of safety . organization and contact for each relationship type. Create visible partnerships with the public around patient safety initiatives. Leverage the bedside nurse in the provider/technology partnership to enable ownership and effective implementations.

9 Shape the external environment to support patient safety . For the role of the nurse executive in patient safety GuidinG PriNciPlEs 2. Figure 1: Sample Goals/Objectives by Organization for Building External Relationships Partner Objectives Academia yy Develop best practices. yy Drive effective curriculums that reflect working realities and include PriNciPlEs of safety . yy Appoint joint facility to train nurses. yy Align graduation nurses and workforce needs to mitigate shortages. Technology solution provider yy Sponsor seminars and users groups to share new innovated practices. yy Work together to understand the people, processes, and technology changes required for designing safe systems. yy Work with bedside nurse to promote ownership and effective implementation of new technologies. Communities yy Create visible partnerships with the public around patient safety inititatives.

10 Policy makers in health care yy Define the issues and solutions to shape public policy. regulatory agencies State and federal agencies yy Monitor issues from standard-setting committees, comment when regulations are published, participate when possible. yy Monitor issues and trends on patient safety topics. yy Offer written comment and proposals and key legislation. yy Provide written comment and testimony during public comment periods. Professional organizations yy Join committees that help shape positions on key issues. yy Participate in annual and local meetings to share your organization's best practices. Patient and family yy Involve patient and family in process redesign and policy formation. Develop Leadership Competencies Leadership competencies around patient safety are Enhance and focus the patient safety skills of future intended to identify and establish skills common to nurses nurse leaders.